Do you find anesthesia intellectually stimulating?

[Maybedoc1]

3rd year (post clerkship) student trying to figure out what to do with my life. At the moment I'm between critical care (from EM, IM, or anesthesia) or radiology. Might sound strange (and it probably is) but here we are. I feel like each of these specialties have significant positives and negatives and I feel like I'm making no progress in my decision. I've shadowed anesthesia a few times and there's components of it that I really like, but I feel that it's also hard to get a feel for as a student. I think some of the best perks of anesthesia (no notes, no rounds) make it hard to appreciate all the thought that can go into getting someone through a surgery safely. From the outside it can look like pushing propofol, intubating, and chilling on your phone or leaving the CRNA as you go to the next room. I also don't feel like I've seen any "big cases" where an anesthesiologist is really needed and I realize there's gotta be a big difference between a d1 athlete getting an ACL repaired and a cirrhotic with a MELD of 40 getting a liver transplant. I do think it's cool that the same specialty can do both of these things though.

I don't necessarily think that any specialty after intense residency/fellowship training is really 100% intellectual wonder day in and day out. Most things are probably routine in every specialty after a while, but I'm wondering how you all feel about this in anesthesia?

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[ToKingdomCome]

I do but not as much as other specialities. So I Did a critical care fellowship to get that fix

 

[Lecithin5]

I mostly do my own cases. Like most things in life, things get routine after a while. 99 percent of my job is pretty routine (doesn’t mean that the 99 percent doesn’t require my expertise or skill or knowledge); 1 percent gets my juices flowing and can be challenging/stimulating. I still love it all.

Kind of like a pilot- after a while, a seasoned pilot probably doesn’t get too excited when he/she flies.

 

[GassYous]

I just want my days to be efficient and unexciting. Nothing worse than having some vats patient be hypoxic or some old hip fracture lady be pericode.

 

[DrN2O]

Just because the "same specialty can do the D1 athlete ACL and transplant for MELD 40" doesn't mean the same doctor can do both. Sub-specialization often provide the intellectual stimulation that individuals seek, no matter what broad specialty you choose. Infectious disease, neurosurgery, come to mind that are more stimulating than anesthesia. Personally, I find it most stimulating when I watch cardiology and surgery contorting themselves to deliver "extraordinary care".

 

[vector2]

3rd year (post clerkship) student trying to figure out what to do with my life. At the moment I'm between critical care (from EM, IM, or anesthesia) or radiology. Might sound strange (and it probably is) but here we are. I feel like each of these specialties have significant positives and negatives and I feel like I'm making no progress in my decision. I've shadowed anesthesia a few times and there's components of it that I really like, but I feel that it's also hard to get a feel for as a student. I think some of the best perks of anesthesia (no notes, no rounds) make it hard to appreciate all the thought that can go into getting someone through a surgery safely. From the outside it can look like pushing propofol, intubating, and chilling on your phone or leaving the CRNA as you go to the next room. I also don't feel like I've seen any "big cases" where an anesthesiologist is really needed and I realize there's gotta be a big difference between a d1 athlete getting an ACL repaired and a cirrhotic with a MELD of 40 getting a liver transplant. I do think it's cool that the same specialty can do both of these things though.

I don't necessarily think that any specialty after intense residency/fellowship training is really 100% intellectual wonder day in and day out. Most things are probably routine in every specialty after a while, but I'm wondering how you all feel about this in anesthesia?

I think most routine anesthesia becomes especially unstimulating the farther out you get (which is a blessing if that's what you're looking for). This is compounded by the fact that anesthesia has had very few technological, procedural, and pharmacological advances compared to other specialties. I mostly get my intellectual / procedural fix from doing TEE, major cardiothoracic/vascular anesthesia, and critical care.

 

[T-burglar]

I think most routine anesthesia becomes especially unstimulating the farther out you get (which is a blessing if that's what you're looking for). This is compounded by the fact that anesthesia has had very few technological, procedural, and pharmacological advances compared to other specialties. I mostly get my intellectual / procedural fix from doing TEE, major cardiothoracic/vascular anesthesia, and critical care.

Same. OP, I went to medical school after growing up watching “ER”. I love resuscitation medicine and the heart/chest/circulation , and I don’t like much else.

I ended up in cardiothoracic anesthesia and I love my job when I’m in those cases. if I’m doing run of the mill general anesthesia I am not intellectually stimulated and hate it . I’ve been an attending since 2017.

I also made my way into a leadership position in CT and I’m finding now that so many problems require systems level fixes. So my interests are evolving, now I’m becoming interested in systems level practice. And this is what I find intellectually stimulating lately.

 

[Hoya11]

3rd year (post clerkship) student trying to figure out what to do with my life. At the moment I'm between critical care (from EM, IM, or anesthesia) or radiology. Might sound strange (and it probably is) but here we are. I feel like each of these specialties have significant positives and negatives and I feel like I'm making no progress in my decision. I've shadowed anesthesia a few times and there's components of it that I really like, but I feel that it's also hard to get a feel for as a student. I think some of the best perks of anesthesia (no notes, no rounds) make it hard to appreciate all the thought that can go into getting someone through a surgery safely. From the outside it can look like pushing propofol, intubating, and chilling on your phone or leaving the CRNA as you go to the next room. I also don't feel like I've seen any "big cases" where an anesthesiologist is really needed and I realize there's gotta be a big difference between a d1 athlete getting an ACL repaired and a cirrhotic with a MELD of 40 getting a liver transplant. I do think it's cool that the same specialty can do both of these things though.

I don't necessarily think that any specialty after intense residency/fellowship training is really 100% intellectual wonder day in and day out. Most things are probably routine in every specialty after a while, but I'm wondering how you all feel about this in anesthesia?

its funny that you have that perspective. its hard to be interested in anesthesia if you dont understand whats going on.

im a general anesthesiologist, doing mostly ambulatory cases now, dealing with pedi airways, and blocks, and busy rooms with high turnovers, time pressure. my day is always interesting. meeting interesting patients, taking good care of them, keeping things churning uneventfully.

i personally think radiology and critical care are incredibly boring, right up there with rheumatology, dermatology, pediatrics, pathology.

if you are looking for a long long time to think over and ponder lots of different diagnoses with no time pressure, radiology and critical care right up your alley. "intellectually stimulating" means different things to different people. to you i am inferring that it means lots of time for long periods of thinking things over.. not descriptive of general anesthesia practice... where you have to move rapidly and know how not to make horses into zebras

 

[kidthor]

Same. OP, I went to medical school after growing up watching “ER”. I love resuscitation medicine and the heart/chest/circulation , and I don’t like much else.

I ended up in cardiothoracic anesthesia and I love my job when I’m in those cases. if I’m doing run of the mill general anesthesia I am not intellectually stimulated and hate it . I’ve been an attending since 2017.

I also made my way into a leadership position in CT and I’m finding now that so many problems require systems level fixes. So my interests are evolving, now I’m becoming interested in systems level practice. And this is what I find intellectually stimulating lately.

Interesting - we are very similar. I loved the show ER and it was a component of me going into medicine. In fact I even dual applied to EM and anesthesiology, but quickly dropped the notion of EM once I realized that the anesthesia people were my more my speed (no offense to EM, they're cool too).

I can find routine general cases somewhat intellectually uninteresting too, however some easy days like that can be a welcome break. FWIW even my neurosurgery friends often also find that their jobs become rather routine and perhaps even boring. That said, when I'm doing peds anesthesia (my subspecialty) I'm almost always happy to go to work because I love helping sick kids and collaborating with everyone else in the hospital - it's usually a joy.

In a way intellectual stimulation could come from research... but research in anesthesiology is fairly weak overall. And honestly I think research in many other fields is increasingly less important. The current medical system incentivizes us all to just work more and complain(/advocate) less, with little to no reward for research. In fact you might even be effectively penalized for doing research depending on how you look at it. I know some brilliant researchers but their lives are rough with all the grant writing, paper writing, conference-going, and requirements to "pay" for their non-clinical time - on top of their generally busy clinical schedules. Consider that for many institutions working 40 clinical hours is "part time" and then researchers may tack on another 20 hours of research time on top of that. Madness, in my opinion.

To that end I'm with T-burglar - intellectually I find systems level issues to be the most interesting and most tangible. I also think systems level ideas can have a positive impact on many patients all at once, as well as a positive impact on healthcare professionals.

 

[ToKingdomCome]

its funny that you have that perspective. its hard to be interested in anesthesia if you dont understand whats going on.

im a general anesthesiologist, doing mostly ambulatory cases now, dealing with pedi airways, and blocks, and busy rooms with high turnovers, time pressure. my day is always interesting. meeting interesting patients, taking good care of them, keeping things churning uneventfully.

i personally think radiology and critical care are incredibly boring, right up there with rheumatology, dermatology, pediatrics, pathology.

if you are looking for a long long time to think over and ponder lots of different diagnoses with no time pressure, radiology and critical care right up your alley. "intellectually stimulating" means different things to different people. to you i am inferring that it means lots of time for long periods of thinking things over.. not descriptive of general anesthesia practice... where you have to move rapidly and know how not to make horses into zebras

"if you are looking for a long long time to think over and ponder lots of different diagnoses with no time pressure, radiology and critical care right up your alley. "

lol i dont think any critical care anesthesiologist is doing this. maybe micu.

 

[nimbus]

Relative to some other specialties anesthesia is not intellectually stimulating but it is still very interesting on a daily basis. In particular, I enjoy the on the spot problem solving and the technical challenges. They require a modicum of intelligence but I wouldn’t consider them to be intellectual activities. Then there is the “table up, table down” aspect of anesthesia which is arguably less intellectual than being a waiter or gardener

 

[Realgassy]

Personally, the best days in anesthesia are the ones where absolutely nothing interesting happens. A straightforward efficient day or a couple long robot cases with a good book is ideal. Frankly, I think a lot of my colleagues would agree.

In general, you have to be ok with going with the flow of the OR - you usually aren’t the one in charge until **** hits the fan. To an extent you can pick a job with sicker patients - this lends itself to more “excitement.” I wouldn’t necessarily say those exciting moments are intellectually stimulating until you reflect on them later. Things happen quickly and you are doing everything you have been trained to do to keep the patient safe.

I spent a month in med school doing anesthesia. I realized I had found my people.

 

[Barleycorn]

You could always do pain and anesthesia, both are challenging in different ways, and give a nice break from the other.

 

[Angus Avagadro]

Relative to some other specialties anesthesia is not intellectually stimulating but it is still very interesting on a daily basis. In particular, I enjoy the on the spot problem solving and the technical challenges. They require a modicum of intelligence but I wouldn’t consider them to be intellectual activities. Then there is the “table up, table down” aspect of anesthesia which is arguably less intellectual than being a waiter or gardener

LOL! My old Chief told us to always have the table at the highest setting to start the case. Then the surgeon says "Lower the table ...Please."If it's too low, they merely say .." Raise the table".

 

[pgg]

I don't really know what "intellectually stimulating" means in the context of medicine.

A job or specialty can be difficult, demanding, and satisfying without being exciting or requiring a lot of decisions that need deep thought.

In many specialties, most of the thought and deliberation is in weighing risk/benefit issues when deciding on a treatment. There isn't a lot of Dr. House or Scooby Doo mystery solving going on, anywhere. Even the stereotypical deep-thinking fleas / int med subspecialists of the medicine world are still doing the same routine stuff 98% of the time. For every zebra they see there are 182 COPD exacerbation or ACS horses. To me that's more like running on a treadmill and occasionally looking out the window to see if the weather has changed.

Just because something is simple or routine doesn't make it easy. Anesthesia done well often looks like we're doing nothing at all.

 

[Maz777]

I don't find it intellectually stimulating on a daily basis.

I do find it artfully stimulating. I like the challenge of providing a safe, complication-free, and efficient anesthetic on every patient. The artform of anesthesia. There's a big difference between a complication-free rate of 99% and 99.9%.

 

[nimbus]

Academics is always an option to scratch your intellectual itch. There are still a lot of unanswered questions in anesthesia. That said, this kind of bench work and computational modeling can be very tedious and not rewarding.

https://www.nature.com/articles/s41598-021-83714-y.pdf?pdf=button%20sticky

 

[DesiredMemberName?]

Mask-inducing a single ventricle kid can be intellectually stimulating.

Reading Ulysses during a long stable robotic case can be intellectually stimulating.

Different strokes…

 

[pocafx]

My problem is doing 15 colons in a day or 10 cystos. Not enough time to read and not stimulating or rewarding

 

[Beeftenderloin]

My problem is doing 15 colons in a day or 10 cystos. Not enough time to read and not stimulating or rewarding

Some days it’s turn and burn, some days it’s a circ-arrest, hemi arch, triple valve, in a cirrhotic, other days it’s a 12 hour free-flap and you’re emptying the urimeter q15 minutes to stay awake. They all have their place, and each one makes you appreciate the other in its own way. You just can’t do too many of any one of them too close together.

 

[triggermaster]

Mask-inducing a single ventricle kid can be intellectually stimulating.

Reading Ulysses during a long stable robotic case can be intellectually stimulating.

Different strokes…

I agree with this except read Ulysses at home and pay the bills doing something positive and moral at work (most high paying jobs are neither). I don’t think anything remains intellectually stimulating unless it’s constantly changing, and that probably wouldn’t be a good thing.

 

[nimbus]

My problem is doing 15 colons in a day or 10 cystos. Not enough time to read and not stimulating or rewarding

Those days are for $$$, not for intellectual stimulation.